Background:Psoriatic arthritis (PsA) is associated with insufficent levels of vitamin D (25OHD) and an increased cardiovascular risk. Several studies, have shown an inverse relationship between 25OHD levels and cardiovascular damage.Objectives:To study the relationship between 25OHD and vascular damage, as well as its possible influence on its progression, in patients with PsA.Methods:Pre-post longitudinal study with analytical components. PsA patients with peripheral joint involvement were included. Demographic (sex, age), clinical [follow-up time, DAPSA, current treatment, body mass index (BMI), classic vascular risk factors, vascular events] and analytical variables [atherogenic index, glomerular filtration (GF-MDRD), glycosylated hemoglobin (HbA1c), CRP, ESR, 25OHD] were collected. We considered deficient level of 25OHD <20 ng/ml and insufficient <30 ng/ml. Basal vascular risk was estimated through SCORE tool. Extracranial carotid artery was explored with an Esaote MyLab70XVG ultrasound with linear probe (7-12mHz) and an automated program that measures intima media thickness (IMT) by radiofrequency, and the presence of atheroma plaques was evaluated following Mannheim consensus. Pulse wave velocity (PWV) was measured through Mobil o graph® dispositive. IMT≥900 µ and PWV≥ 10m/s were considered as pathological values. We repeat vascular study 3 years later. Vascular damage progression was defined as the appearance of atheroma plaques during the follow-up and/or an increase in their number. Statistical analysis was performed using SPSS 22.0 program.Results:78 patients were included. Eighteen patients were excluded due to high vascular risk [previous event, diabetes type II or type I with target organ injury and/or GF-MDRD< 60 ml/min]. 57.5% were women with a mean age of 54.2 (SD 10.9) years. The mean follow-up time was 96.8 (SD 163.6) months and mean DAPSA was 10.2 (SD 8.3). 96.2% of patients had received DMARDs and 42.3% biologicals, and 42.3% took calcium and 25OHD supplements. Mean BMI was 27.5 (SD 4.7) kg/m2. 42.3% had tobacco exposure, 29.5% were hypertensive and 32% dyslipidemic. Mean SCORE was 1.6 (SD 1.8) and mean 25OHD was 27.6 (DSD 11.6) ng/ml. 28.2% patients had 25OHD deficit and 60.3 % insufficiency. At the beginning, 32.1 % of patients had atheromatous plaques with a number of plaques around 1.7 (SD 1.2), and 6.7% and 19.7% had a pathological IMT or PWV, respectively. Baseline, we had not observed any association between 25OHD and the presence of atheroma plaques, IMT or PWV. Three years later, we detected progression of vascular damage in 31.2% patients. In these patients, the existence of hypovitaminosis D was associate with the appearance of atheroma plaques (p=0.043). This association desappeared in the multivariate analysis, in which only the CRP influenced the appearance of atherome plaques (OR: 1.4, IC 95% 1.04-1.98, p=0.025).Conclusion:Low 25OHD levels are not related to vascular damage or influence a posible progression of it in our serie. As might be expected, the progression of vascular damage depends on the inflammatory load in these patients.Disclosure of Interests:L Montolio-Chiva: None declared, M Robustillo-Villarino: None declared, Ana V Orenes Vera: None declared, Marta Aguilar-Zamora: None declared, C Vergara-Dangond: None declared, I Vázquez-Gómez: None declared, Eduardo Flores: None declared, A Sendra-García: None declared, À Martínez-Ferrer: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, V Núñez-Monje: None declared, I Torner-Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis
BackgroundOsteoporosis (OP) is a systemic bone disease characterised by decreased bone mass and deterioration of bone microarchitecture with increased brittleness and fracture risk. It associates high morbidity and mortality for patients and has a high impact on health expenditure. Bone marrow stromal mesenchymal stem cells (BM-MSC) give rise to osteoprogenitor cells and osteoblasts and influence bone homeostasis. However after their intravenous (i/v) infusion their osteotropism is limited. Our group has demonstrated that the exofucosylation of the CD44 membrane antigen in MSC improves their homing to bone tissue and that the infusion of these cells is safe in a murine model.ObjectivesTo evaluate the safety of i/v infusion of fucosylated BM-MSC in patients with OP, and secondarily assess their ability to improve the course of the diseaseMethods10 women between 50 and 75 years old diagnosed with osteoporosis with a low impact fracture will be included and treated i/v with autologous fucosylated BM-MSC. The first 4 patients were treated with a dose of 2 × 106 cells/kg body weight and the other 6 with 5 × 106 cells/kg body weight. A 24 month follow-up will be conducted to evaluate the rate of severe and non-serious adverse events and secondary endpoints (decreased fracture rate, pain scores, functional status and quality of life, biochemical indexes of bone metabolism, quantitative computed tomography for morphometric and mechanical analysis of bone quality, densitometry, and histomorphometryResultsSeven patients have been recruited to date. Two left the study for lack of cell proliferation and appearance of a complex form in karyotype during the cell culture, respectively. The first 4 patients were successfully infused, and after a median follow-up of 3 months no related adverse effects have been observed, no new osteoporotic fractures have appeared, and the analogue pain scale score (EVA) shows a tendency to decrease of pain in 3 of the 4 patients.ConclusionsOur preliminary data indicate that clinical and GMP-grade production of BM-MSC is feasible. We have not observed any short-term adverse effects associated with treatment in infused patients.Disclosure of InterestNone declared
Background:In axial spondyloarthritis (axSpA) the risk of vertebral fracture is increased, not always corresponding with the values of bone mineral density (BMD). One possible explanation is that syndesmophytes interfere with these values. We consider whether the evaluation of trabecular microarchitecture by an accessible methodlike the Trabecular Bone Score (TBS), that does not involve additional irradiation neither seem to be influenced by the presence of syndesmophytes, may be an advantage to estimate the risk of fracture.Objectives:To estimate the prevalence of vertebral fractures in patients with axSpA. To assess the diagnostic accuracy of TBS and BMD for vertebral fracture, and if it is influenced by the presence of syndesmophytes. To analyze the correlation between the absolute values of BMD and TBS in the lumbar spine.Methods:Cross-sectional study. Patients were consecutive recruited. We collected demographic (sex, age), clinical (syndesmophytes, vertebral fracture, BASDAI, BASFI, time of evolution of axSpA, treatment) and analytical variables [vitamin D (1,25-OHD), CRP and ESR]. The BMD was determined using the Lunar Prodigy ProTM densitometer from GE Healthcare, to which the TBS iNsight® software version 2.2 was added to perform the TBS analysis. The presence of fracture was evaluated by radiology. The statistical analysis was performed with the SPSS 22.0 and OpenEpi softwares.Results:84 patients were included, 60 men and 24 women, with a mean age of 59 years (± SD 13). 51.2% had lumbar syndesmophytes. The prevalence of fractures was 13.7%, 95 CI (7.8-22.9). 51.2% were treated with NSAIDs, and 48.8% with biological drugs. The evolution of axSpA was > 10 years in 65.5%. The mean scores of BASDAI and BASFI were 3.7 and 4.3 respectively (± SD 2.2 and 2.3). The mean CRP value was 8.5 mg / L (± SD 8.4), ESR 12.2 mm / h (± SD 11.4) and 1.25-OHD 27.9 ng / dL (± SD 13.6).According to the lumbar and femoral T Score, 9.5% and 15.5% of the patients were in the range of osteoporosis respectively.19% patients had a low TBS value (≤1.23).Regarding the influence of syndesmophytes on TBS and BMD values, we found significant differences in lumbar spine BMD (p = 0.01) but not in total hip and femoral neck BMD (p = 0.2 and 0.3 respectively) nor in the TBS (p = 0.1).Regarding the correlation of TBS and BMD values of the spine, no correlation was observed in patients with syndesmophytes, while a moderate correlation (r = 0.4, p = 0.02) was observed in patients without syndesmophytes.In the univariate analysis, the factors related to the presence of vertebral fracture were age, female sex, absolute BMD values in the lumbar spine and total hip, and TBS values. No relationship was found with the rest of the variables. In the multivariate analysis, only the TBS showed a significant association with the presence of fractures (p =0.02).Regarding the predictive capacity of fractures, TBS showed a higher sensitivity than that of BMD (55.6% versus 18.2% and 30% of BMD in the spine and hip respectively), being the specificity comparable (85.3% versus 91.3% and 85.1% of BMD in column and hip respectively).Conclusion:the prevalence of fractures was 13.7% among the patients studied, 95 CI (7.8-22.9). The presence of syndesmophytes influenced the values of lumbar BMD but not the hip BMD or those of the TBS. We found a correlation between the values of BMD of the spine and TBS only in patients who did not have syndesmophytes. Only TBS values were significantly related to the presence of fractures in the multivariate analysis. TBS showed greater sensitivity with similar specificity than BMD for the detection of vertebral fractures.Disclosure of Interests:Ana V Orenes Vera: None declared, L Montolio-Chiva: None declared, I Vázquez-Gómez: None declared, Eduardo Flores: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, À Martínez-Ferrer: None declared, Desamparados Ybañez: None declared, Luis García-Ferrer: None declared, María Vega-Martínez: None declared, Magdalena Graells-Ferrer: None declared, A Sendra-García: None declared, V Núñez-Monje: None declared, Inmaculada Torner Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis
Background:Arthritis of viral aetiology is considered the most frequent cause of acute arthritis. The most common etiologic agent is parvovirus B19 (B19). Besides, other viruses can lead to inflammatory joint disease, such as Epstein-Barr virus (EBV), Cytomegalovirus (CMV), Human immunodeficiency virus (HIV), Rubella, Mumps, Hepatitis B and C virus (HBV and HCV) and Chikungunya (in transcontinental travellers or immigrants).Objectives:To describe the epidemiological characteristics, clinical and analytical course, evolution and treatment of a series of patients with a confirmed diagnosis of viral arthritis.Methods:A descriptive study was performed, considering a series of cases of viral arthritis collected between 2000 and 2019. Epidemiological (sex, age, the season of the year, year of diagnosis, children of pediatric age), clinics (joint pattern, prodromes, accompanying clinic) and analytical (CRP, ESR, ANA, RF) variables were collected. Statistical analysis was performed with the SPSS 22.0 program.Results:The data of 131 patients (109 women, 22 men), with a mean age of 39.7 years (SD 11.9) were collected. 93.9% of the cases were produced by B19, 3.8% by EBV, and only 3 by other viruses (1 by CMV, 1 by HBV, 1 by Mumps). The highest incidence years were 2005(55 cases), 2000(10 cases) and 2016(8 cases). Almost half of the cases (46.6%) occurred in spring, while 32.8% in summer, 15.3% in winter and 5.3% in autumn. Contrary to the expectations, only 20% of the patients had children in pediatric age.The most frequent clinical picture was acute polyarthritis (53.4%), followed by inflammatory polyarthralgias (19.1%). Moreover, acute oligoarthritis was present in 10.7% of cases, and acute monoarthritis in 3.1% of cases. More than half of the patients (54.2%) had prodromes, most frequently respiratory symptoms, and the joint clinic was accompanied by a skin rash in 35.1% and fever in 29% of cases. Analytically, 33.6% presented high CRP, 39.7% high ESR, 19.8% transient anemia, 9.9% positive ANA (4.6% transiently), 9.1% anti dc-DNA (7.6% transiently), and 10.7% positive RF (3.1% transiently). In 79.4% of cases, the clinic picture was limited, with a mean duration of 36 days (SD 47.7), but 12.3% had recurrences. The 69.5% of the patients needed treatment with acetaminophen and/or NSAIDs (6.7% did not need treatment), but corticotherapy was needed in 21.4% of cases. 4.6% of the cases evolved to chronicity, which made DMARD necessary in 3 patients (two of them with a final diagnosis of rheumatoid arthritis, being treated with Methotrexate and Leflunomide, and the third one had a diagnosis of undifferentiated connective disease, treated with Hydroxychloroquine).Conclusion:B19 remains the most common cause of viral arthritis in our population. It appears with a sporadic, occasionally epidemic, pattern of presentation, predominantly in warm seasons. A clinical presentation as an oligoarthritis or an acute monoarthritis or even the positivity of autoimmunity markers, should not make us rule out this possible aetiology. One out of 20 cases can evolve to chronicity and even make necessary the addition of DMARD.Disclosure of Interests:Ana V Orenes Vera: None declared, I Vázquez-Gómez: None declared, L Montolio-Chiva: None declared, Eduardo Flores: None declared, Desamparados Ybañez: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, À Martínez-Ferrer: None declared, A Sendra-García: None declared, V Núñez-Monje: None declared, Inmaculada Torner Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis, Nagore Fernandez-Llanio: None declared
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